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The Mediating Role of Sleep Quality in Associations of Smartphone Addiction and Time-Specific Use With Prenatal Depression and Anxiety: Cross-Sectional Observational Study

Year: 2026

Type: article

Abstract: Background: Prenatal depression and anxiety have emerged as pressing global public health challenges. In the digital era, excessive smartphone use may exert complex effects on maternal mental health. Prior research has predominantly focused on adolescents, whereas evidence among pregnant women, particularly regarding total weekly use and use during critical circadian windows, such as after waking and before bedtime, remains limited. Furthermore, the mediating role of sleep quality in these associations has yet to be systematically examined. Objective: This study aimed to investigate the associations of smartphone addiction and time-specific smartphone use with prenatal depression and anxiety, and to assess the mediating role of sleep quality in these associations. Methods: This cross-sectional observational study enrolled 537 pregnant women. Smartphone use characteristics, sleep quality, and prenatal depression and anxiety were assessed using the Smartphone Addiction Scale-Short Version (SAS-SV), objective total weekly smartphone use recorded by the device, and self-reported duration of smartphone use after waking and duration of bedtime smartphone use; the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Binary logistic regression was used to estimate associations, restricted cubic spline (RCS) models were used to explore nonlinear patterns, and exploratory mediation analyses were used to examine whether sleep quality statistically accounted for part of the observed associations. Results: The prevalence of moderate-to-severe prenatal depression and anxiety was 8.8% (47/537) and 5.8% (31/537), respectively. After adjusting for covariates, smartphone addiction was associated with higher odds of depression (odds ratio [OR] 3.461, 95% CI 1.771-7.100) and anxiety (OR 7.738, 95% CI 3.064-23.172). Duration of smartphone use after waking ≥61 minutes and duration of bedtime smartphone use ≥91 minutes were also associated with higher odds of affective disorders. RCS analyses further revealed distinct nonlinear patterns across different exposure dimensions: duration of smartphone use after waking displayed U-shaped and J-shaped associations with depression and anxiety, respectively, while total weekly use displayed a U-shaped association with anxiety. Exploratory mediation analyses showed that the indirect pathways through sleep quality were statistically significant for the associations of bedtime smartphone use, weekly smartphone use, and smartphone addiction with prenatal depression, with mediation proportions of 44.89% (0.0065/0.0145), 31.30% (0.0056/0.0183), and 31.48% (0.0415/0.1315), respectively. The corresponding proportions in the anxiety models were 35.83% (0.0044/0.0123), 27.05% (0.0039/0.0144), and 22.73% (0.0271/0.1187). Conclusions: Smartphone addiction and excessive smartphone use after waking and before bedtime were associated with higher odds of prenatal depression and anxiety. Sleep quality may statistically account for part of these associations, but longitudinal studies are needed to establish temporal ordering and causal pathways.

Source: JMIR mhealth and uhealth

DOI: 10.2196/100064